146 | Chapter 7 FPP participants noticed that booster sessions should be organized to refresh the information and exercises of the program and to determine if more follow-up actions are needed for the FPP participants. DISCUSSION We conducted a process evaluation with FPP participants, therapists and other stakeholders to identify how FPPs can be optimized and further implemented in the community. We found that FPP participants, therapists and stakeholders in general were satisfied with the training program and would recommend it to older adults with an increased fall risk. Moreover, we identified six themes that are important in optimalisation and implementation of FPPs: (1) Recruiting and motivating older adults to participate, (2) Structure and content of the program, (3) Awareness, confidence and physical effects, (4) Training with peers, (5) Funding and costs, and (6) Long-term continuation. These themes will be further discussed below with resect to literature and in terms of recommendations. Recruiting and motivating older adults to participate Participants suitable for participation in the FPP are older adults who experienced a fall before and/or have fear of falling and therefore are intrinsically motivated to participate in a FPP (136). To recruit a suitable target group, people need to be actively recruited in the local and social domain, and an easy applicable screening tool is needed, as recommended in guidelines for fall prevention (41). Structure and content of the program As also seen in other research, a combination between education and exercises was experienced as positive (179). Exercises should focus on activities of daily living and situations in practice, which may increase adherence to continue doing the exercises at home (284). There should be enough variation and different difficulty levels in the exercises to keep participants engaged in the FPP (285). It was experienced as positive that the training could be tailor-made for the participants so that every participant can train on their own level, while being challenged, to maintain effectiveness (286). Also training with the same group and same therapist was mentioned a facilitator and can provide structure to the FPP. The high number of training sessions was mentioned as a barrier by therapists and stakeholders. However, this intensity of training sessions is one of the core components of effective fall prevention programs and should be maintained to preserve the effectiveness of FPPs (137). Future programs might consider explaining this in more detail to particpants. For individuals who are unable or unwilling to commit to two out of house weekly exercise sessions, internet based interventions, such as StandingTall (277), may serve as an additional viable solution.
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